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Tuesday Sep 03, 2019

Social Media Influencers or FPs: Who Do Patients Trust?

How do you receive trustworthy medical advice? You may read journals such as American Family Physician, use online resources such as DynaMed or even rely on senior physicians to share their wisdom. But have you ever considered basing your medical decisions on the number of likes a particular post gets on Instagram?

[group of people using smartphones]

Millions of Americans do.

Social media influencers(www.nytimes.com) are the latest source of health information(www.healthline.com) for many Americans. Influencers are social media users who have large online followings, and there are a growing number of them entering the health and wellness space with varying messages and impact. There are wellness advocates such as author Kris Carr,(twitter.com) a cancer survivor whose messages are geared toward inspiring and motivating her followers to pursue their own health goals. However, there also are influencers who promote more radical messages and health tips, such as suggesting that underwire bras could lead to cancer(www.dailymail.co.uk) or plugging the health benefits of being stung by a bee.(www.telegraph.co.uk)

As a family physician, I have noticed the growing power social media has on behavior change in my patients. I see patients who are excited to try new diets, exercise routines and wellness trends they have seen on social media. The problem is that some of the health advice they are receiving online is not supported by medical evidence and can even be harmful. Even more concerning are the patients who are more inclined to take advice posted by nonmedical professionals than recommendations from me, a physician who has dedicated the better part of a decade to medical training and caring for patients. So, why are some social media influencers able to motivate behavior change more effectively than physicians?

Barriers to Doctor-Patient Connections

Physicians have a small window to make changes in a patient's life. Primary care visits typically last just 10 to 20 minutes,(www.reuters.com) and we must get an entire medical history, triage acute concerns, do a physical exam and check off any other boxes that are encouraged by our institutions and payers to maximize reimbursement. Even though a primary care physician works about 8.6 hours per day(www.annfammed.org) in the office, face-to-face patient care accounts for only about 27% of that time,(annals.org) with the rest being spent on charting or additional administrative work. This leaves little, if any, time to really get to know our patients, let alone have them get to know us.

And that is assuming a patient can be seen at all with the hurdles of health care costs, appointment availability(www.healthypeople.gov) and transportation barriers that many patients must overcome before we can even discuss health behavior change.

On the other hand, the extremely easy access most people have to social media -- which millions of Americans carry in their pockets or bags every day -- gives influencers far more opportunities than physicians to reach their target audience and help shape behavior.

How Influencers Earn Trust

Primary care physicians' time and administrative work constraints hinder the development of a trusting relationship, but how is it that a social media influencer -- who likely has never met or spoken to our patients -- is able to garner their trust?

Social media influencers may not have a close relationship with their followers, but followers can certainly feel close to them. Followers are transported away from their normal routine and brought along on the journey of a celebrity's life. The follower sees what makes this person happy and sad, is made privy to their beliefs and witnesses what they stand for. The more authentic influencers appear, the more trustworthy they become.(variety.com)

Even if a person doesn't buy into an influencer's brand or story, a retweet or promotion of that influencer's post and beliefs from a trusted friend or family member gives the health message new value and meaning.(stackla.com)

An influencer who does not have any medical training can still gain perceived credibility from their unique lived experiences. The authenticity of these experiences is supported by each picture posted and every story illustrating how the influencer's beliefs impacted his or her life that day.

This is the power of storytelling; there have been several studies demonstrating its profound effect(journals.sagepub.com) on health behavior change.

Although citing research studies and statistics is important for validating medical recommendations, we cannot ignore the strong impact of a personal story on inciting change. Social media influencers provide a steady stream of stories to back up their health tips, so I am not surprised that my patients aren't particularly impressed by my ability to cite numbers demonstrating the link between quitting smoking and preventing heart attacks.

How can we stay relevant when health advice from physicians is being overshadowed by this influx of new voices and opinions?

Rekindling the Doctor-Patient Relationship

Like any business facing a strong competitor, we need to evolve. Some physicians have taken to social media themselves to connect with their patients and have become powerful advocates for health and change. Family physician and Fresh Perspectives blogger Natasha Bhuyan, M.D., is appearing in a series of YouTube videos(bit.ly) for BuzzFeed's As/Is channel in which she answers frequently asked questions about women's health issues.

Other examples abound. Emergency physician Esther Choo, M.D., M.P.H., has more than 72,000 Twitter followers(twitter.com) and is calling out sexual harassment and inequality in the health care workplace through Time's Up Healthcare.(www.timesuphealthcare.org) In a recent interview in JAMA,(jamanetwork.com) gastroenterologist Austin Chiang, M.D., provided insight on the benefits of having physicians engaged in the social media space, but he noted several pitfalls they may encounter when doing so, including HIPAA violations, promoting false information or the harms of having an inactive social media presence versus no presence at all. It's enough to give any physician pause before opening a public social media account.

Given the nuances of establishing a social media presence, having more physicians sign up for Twitter accounts may not be enough to counteract the social capital influencers already have, but there is something we can do that is more in our wheelhouse. Let's embrace the doctor-patient relationship. Learn where your patients are from, where they grew up, their favorite restaurant. Ask how they are enjoying the latest season of Stranger Things or how their children did on their first day back to school. You won't find these questions included in any HEDIS (Healthcare Effectiveness Data and Information Set) measure,(www.ncqa.org) but getting to know our patients is vital in creating a trusting relationship that can easily surpass a post on social media.

One aspect of my practice that I love is that our model is designed to allow this to happen. Because I have 40 minutes for each physical exam, I don't feel the pressure to triage health concerns, and I have the opportunity to learn who the person in front of me is and be a part of their life. That is why I chose to become a family physician. Establishing a meaningful relationship with my patients gives me purpose and rejuvenates my passion to care for my patients and community.

We chose family medicine to connect with and serve the communities we work in, so we need to continually reorient our practice to reflect that mission. Family physicians want to connect with their patients naturally, but we need to evolve the primary care model to allow this to happen. Giving us more time with our patients is one strategy, but we also can foster a nurturing clinic environment by addressing other administrative and social barriers that hinder formation of a strong doctor-patient relationship. Reforming payment, hiring support staff such as scribes or radically changing the practice to newer models such as direct primary care are just some of the ways we can get back to the roots of family medicine while meeting the financial and administrative demands of our practices.

By prioritizing the doctor-patient relationship, we can reaffirm our role as our patients' go-to source for health advice.

In a time when social media is king, we need to distinguish ourselves from online health influencers by going back to our roots as family physicians and getting to know our patients. We can demonstrate that we genuinely care about their well-being and that they will never need to question the authenticity of our desire to help. In doing so, we can create a relationship of trust that no Instagram post or tweet will be able to influence. But if you would like to start your social media influencer career by tweeting this post, that's OK, too.

Michael Richardson, M.D., is a board-certified family physician and medical director in Boston. He serves on the Massachusetts Academy of Family Physicians Board of Directors. You can follow him on Twitter @mrichardsonMD(twitter.com) and Instagram @drmikerich.(www.instagram.com)

Posted at 02:15PM Sep 03, 2019 by Michael Richardson, M.D.

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